Ectopic intrathoracic hepatic lobe

Case contributed by Jeffrey Hocking
Diagnosis almost certain



Patient Data

Age: 85 years
Gender: Female

Rounded masses projecting adjacent to the right hemidiaphragm

The gallbladder is surgically absent and there is some biliary distension in keeping with biliary ectasia post cholecystectomy.  At the dome of the diaphragm are several lobulated nodules that demonstrate clear hepatic venous drainage on the same attenuation as liver.  This is favored to represent portions of the right lobe herniating through a defect in the right hemidiaphragm or an accessory/ectopic hepatic lobe.

Diverticulosis without diverticulitis.

Case Discussion

True accessory / ectopic hepatic lobes are uncommon, with only a few cases being reported in the literature1. This appearance may be due to incomplete atrophy or regression of liver lobes during embryologic development. In almost all cases in the reported literature the finding was misdiagnosed on initial imaging.

Portal venous phase imaging is ideal to discriminate between other differentials, as it will often show a vascular pedicle, which can be missed on non-contrast imaging.

Differentially this could reflect previous traumatic hernia or a congenital hernia, however, the location is atypical and there was no history of trauma.

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